Referral & Authorization Coordinator - Remote

Wayne State University Physician Group; United States; Hybrid; USD 38,000 - 60,000; Full time

Job summary

Wayne Health is seeking a Referral and Authorization Coordinator to support care delivery and revenue in Detroit, MI. Hybrid schedule with regular in-office attendance is required.

The role focuses on obtaining pre-certifications, coordinating referrals, scheduling outpatient testing, and maintaining clear communication with patients and providers. Strong knowledge of ICD10/CPT and EMR systems is essential.

Qualifications

• High School Diploma or equivalent.
• Minimum 2-3 years insurance, medical prior authorization, billing or Physician Office experience.
• Proficiency in ICD10 and CPT codes.
• Experience navigating EMR systems (NextGen or Athena preferred).
• Strong verbal and written communication skills.

Responsibilities

• Process referrals and submit medical records to insurance carriers for prior authorization.
• Verify patient’s insurance eligibility, benefits and requirements with carriers.
• Schedule imaging and diagnostic appointments.
• Schedule appointments for new and returning patients.
• Request, track and obtain pre-authorizations from insurers.
• Document communications in the EMR and maintain accurate records.
• Prioritize authorizations by urgency to the patient.
• Provide excellent customer service and resolve patient inquiries.

Skills

ICD10/CPT

Outlook

Excel

Teams

EMR navigation

Communication

Customer service

Typing 35 wpm

Education

High School Diploma

Medical insurance experience

Tools

NextGen

Athena

Job description

Serving one million patients and their families annually. Advancing medical knowledge, technologies and practices. Developing and educating the next generation of exceptional health care professionals. With more than 100 locations in hospital-based clinics, outpatient health and specialty care centers, we provide the most advanced medicine and thoughtful, patient-centric care to the greater metro-Detroit community.

About Us

Serving one million patients and their families annually. Advancing medical knowledge, technologies and practices. Developing and educating the next generation of exceptional health care professionals. With more than 100 locations in hospital-based clinics, outpatient health and specialty care centers, we provide the most advanced medicine and thoughtful, patient-centric care to the greater metro-Detroit community.

Job Summary

The Referral and Authorization Coordinator position serves to provide integrated services essential to care delivery and revenue. The R&A coordinator is responsible for obtaining pre-certifications and pre-authorizations for procedures, specialist referral appointments; scheduling for outpatient testing with other providers for Wayne Health. Coordinates processes, documents medical referrals and prior authorizations for a variety of medical services for clinic patients, as requested electronically by clinic providers. They provide excellent customer service when answering incoming calls from patients and the public, schedule appointments, make follow-up phone calls, address complaints, troubleshoot problems and provide information to patients and public. The Referral and Authorization Coordinator role demonstrates a commitment to a patient-centric, efficient health care delivery system that focuses on quality, safety and operational excellence.

Job Description

Note: This role follows a hybrid schedule. Candidates must be able to report to our office in Detroit, Michigan on a regular basis.

Principle Duties and Responsibilities

This role follows a hybrid schedule. Candidates must be able to report to our office in Detroit, Michigan on a regular basis.

• Process referrals and submit medical records to insurance carriers to expedited prior authorization process
• Contact insurance carriers to verify patient’s insurance eligibility, benefits and requirments
• Schedule appointments for imaging and diagnostic services
• Schedule appointments for new and returning patients.
• Request, track and obtain pre-authorization from insurance carriers within time alloted for medical and services.
• Document and communicate patient correspondence/messages accurately to the appropriate personnel/providers.
• Manage all incoming referral repositories: EHR buckets, provider email, faxes, Auth inbox, Teams message groups and document all communication in electronic medical record.
• Request, follow-up and secure prior-authorizations prior to services ordered
• Regularly calls insurance companies to follow-up on authorizations
• Applies detail knowledge of ICD10 and CPT codes
• Achieve individual productivity and quality metrics set by management
• Manage correspondence with insurance companies, physicians, specialist and patients as needed, including documenting in the EMR.
• Review accuracy and completeness of information requested and ensure that all supporting documents are present
• Prioritize the incoming authorizations by level of urgency to the patient
• Provide excellent customer service, anticipates and respond to needs of others in a courteous timely manner, treat others with care and respect.
• Maintain excellent interpersonal skills necessary to establish and promote productive working relationships with physicians, patients and their families and other individuals both inside and outside the clinical practice area.
• Updates patient insurance, email, phone and all demographics as needed for each patient serviced in EHR.
• Monitor insurance changes relative to coverage, authorization requirments
• Support/perform activities related to appeals of any denied authorization
• Answer Wayne Health calls.
• Schedule appointments for new and returning patients.
• Update patient information and patient registration.
• Responds to patient/customer inquiries both over the phone and by email.
• Research required information using available resources.
• Respond to and resolve patient complaints.
• Process referral requests.
• Identify and escape urgent and emergent patient questions.
• Route calls to appropriate resources when unable to resolve the complaint/concern directly.
• Follow up with patients and callers within predefined timeframes set by departments.
• Clearly document all communications and contacts with providers and personnel in standarized documentation requirements according to standard operating procedures.
• Exercise sound judgement and decision-making skills.
• Communicate clearly, take initiative and is flexible.
• Exhibit good interpersonal communications skills.
• Convey a positive and professional image to the patients and the public.
• Work well under pressure.
• Contribute to the team effort.

Education, Licensure/Certification, and Training Required for the Job

• High School Diploma or equivalent required.
• Minimum 2-3 years insurance, medical prior authorization, billing or Physician Office experience.

Skills and Abilities Required

• Working knowledge of ICD10 and CPT Codes
• Able to operate and stay organized when using multiple computer screens and website windows
• Proficiency in Microsoft Outlook, Teams, Word and Excel
• Intermediate medical terminology
• Basic office skills including typing 35 wpm and accurately enter alpha numeric data
• Possess excellent verbal, written communication and problem-solving skills
• Excellent interpersonal skills necessary to establish and maintain productive working relationships with physicians, patients and their families and other people both inside and outside the clinical practice area
• Excellent customer service skills including the ability to use independent thinking, sound judgement and creativity when resolving customer issues or concerns
• Attention to detail in documentation and communication
• Ability to effectively work independently and with a team
• Manage multiple tasks with shifting priorities.
• Knowledge of medical insurance and medical office billing
• Proficient in navigating EHR, Nextgen or Athena system preferred
• Ability to stand/sit for long periods of times and lift up to 50 pounds
• Requires sensitivity to work with seriously ill patients and their families
• Competency of customer service skills

Safety Requirements

Compliance with Department Health and Safety policies and procedures

Working Conditions/Schedules

40 hour work week, hours and days to be determined by the business needs of the department. Additional hours may be required.

Wayne Health is an EEO/AA/Veteran/Disability Employer

In accordance with the US Supreme Court, which has cleared the way for the implementation and enforcement of The Centers for Medicare & Medicaid Services (CMS) Omnibus COVID-19 Health Care Staff Vaccination mandate, Wayne Health has established the following COVID-19 vaccination requirements. Wayne Health requires all employees [temporary employees and contractors] who will interact with the public and/or co-workers, regardless of clinical responsibility or patient contact, to have started their primary vaccination series against COVID-19 or received a sincerely held religious belief or medical exemption. All newly hired employees are required to have received their first vaccination dose prior to their start date of employment and completed primary series as outlined in FDA's prescribing instruction for vaccine administration. New hires must also receive their booster within 30 days after the date that they are eligible to receive it, per CDC guidelines. Exemptions or accommodations to the Wayne Health vaccine requirement may be approved under certain limited circumstances. Anyone with an approved exemption must have weekly PCR COVID-19 testing on their own time and submit the results every Monday, before arriving at work. Employees whose positions are 100% remote are exempt from these requirements.

About Us

Serving one million patients and their families annually. Advancing medical knowledge, technologies and practices. Developing and educating the next generation of exceptional health care professionals. With more than 100 locations in hospital-based clinics, outpatient health and specialty care centers, we provide the most advanced medicine and thoughtful, patient-centric care to the greater metro-Detroit community.